Novel methods to study aphasia recovery after stroke.

The neural mechanisms that support aphasia recovery are not yet fully understood. It has been argued that the functional reorganization of language networks after left-hemisphere stroke may engage perilesional left brain areas as well as homologous right-hemisphere regions. In this chapter, we summarize how noninvasive brain stimulation can be used to elucidate mechanisms of plasticity in language networks and enhance language recovery after stroke. We first outline some basic principles of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). We then present evidence from studies in healthy volunteers for a causal role of the right hemisphere in different language functions. Finally, we review recent studies that used TMS or tDCS to promote language recovery after stroke. Most of these studies applied noninvasive brain stimulation over contralateral right-hemisphere areas to suppress maladaptive plasticity. However, some studies also suggest that right-hemisphere regions may beneficially contribute to recovery in some patients. More recently, some investigators have targeted perilesional brain regions to promote neurorehabilitation. In sum, these studies indicate that language recovery after stroke may integrate left- as well as right-hemisphere brain regions to a different degree over the time course of recovery. Although the results of these preliminary studies provide some evidence that noninvasive brain stimulation may promote aphasia recovery, the reported effect sizes are not striking. Future studies on larger patient collectives are needed to explore whether noninvasive brain stimulation can enhance language functions at a level that is clinically relevant.